Textbook of Small Animal Emergency Medicine

VOLUME 1

Edited by

Kenneth J. Drobatz, DVM, MSCE, DACVIM (IM), DACVECC

Professor and Chief, Section of Critical Care
Department of Clinical Sciences and Advanced Medicine
University of Pennsylvania
Philadelphia, PA;

Senior Fellow of the Center for Public Health Initiatives
University of Pennsylvania
Philadelphia, PA
USA

Kate Hopper, BVSc, PhD, DACVECC

Associate Professor, Small Animal Emergency & Critical Care
Department of Veterinary Surgical and Radiological Sciences
School of Veterinary Medicine
University of California, Davis
Davis, CA
USA

Elizabeth Rozanski, DVM, DACVIM (SAIM), DACVECC

Associate Professor
Department of Clinical Sciences
Cummings School of Veterinary Medicine
Tufts University
North Grafton, MA
USA

Deborah C. Silverstein, DVM, DACVECC

Professor of Critical Care
Department of Clinical Sciences and Advanced Medicine
University of Pennsylvania
Philadelphia, PA;

Adjunct Professor
Temple University School of Pharmacy
Philadelphia, PA
USA

This edition first published 2019
© 2019 John Wiley and Sons, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Kenneth J. Drobatz, Kate Hopper, Elizabeth Rozanski and Deborah C. Silverstein to be identified as the editors of this work has been asserted in accordance with law.

Registered Office
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA

Editorial Office
111 River Street, Hoboken, NJ 07030, USA

For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.

Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions of this book may not be available in other formats.

Limit of Liability/Disclaimer of Warranty

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging-in-Publication Data

Names: Drobatz, Kenneth J., editor. | Hopper, Kate, editor. | Rozanski, Elizabeth A., editor. |

Silverstein, Deborah C., editor.

Title: Textbook of small animal emergency medicine / edited by Kenneth J. Drobatz, Kate Hopper,

Elizabeth Rozanski, Deborah C. Silverstein.

Description: Hoboken, NJ : Wiley, 2019. | Includes bibliographical references and index.

Identifiers: LCCN 2018002995 (print) | LCCN 2018004342 (ebook) | ISBN

9781119028949 (pdf) | ISBN 9781119028956 (epub) | ISBN 9781119028932

(cloth)

Subjects: LCSH: Veterinary emergencies--Textbooks. | MESH:

Emergencies--veterinary | Pets

Classification: LCC SF778 (ebook) | LCC SF778 .T49 2019 (print) | NLM SF 778

| DDC 636.089/6025 – dc23

LC record available at https://lccn.loc.gov/2018002995

Cover Design: Wiley
Cover Images: (Top) © Jeffrey J Runge DVM, DACVS; (Bottom) © John Donges

CONTENTS

Contributors

Dedication

Preface

About the Companion Website

VOLUME 1

Section 1 Emergency Medicine Overview

1 Goals in Veterinary Emergency Medicine
1. The 40-Year Evolution of Goals in Veterinary Emergency Medicine
2. Principles of Primary Survey, Resuscitation, Secondary Survey and Definitive or Refined Diagnostics and Treatment of Veterinary Emergency Patients
3. References
2 Triage
1. Introduction
2. Telephone Triage
3. Waiting Room Triage
4. Investigation and Stabilization of the Patient
5. References

Section 2 Common Conditions in Emergency Medicine

3 Neurological Disorders
1. Initial Management of the Acute Neurological Patient
2. Neuroanatomic Localization
3. Initial Assessment
4. Neurolocalization
5. Approach to Differential Diagnoses
6. References
4 Respiratory Distress
1. Introduction
2. Does Oxygen Help?
3. Signalment
4. Any Relevant Past Medical History? What Has Happened Today?
5. Is There Hyperthermia or Hypothermia?
6. Is There Loud Breathing?
7. Is There Any Cough or Wheeze?
8. Are There Extra Lung Sounds?
9. What Does Point-of-Care Ultrasound Show You?
10. What Should I Tell the Owner?
11. References
5 Ventricular Ectopy
1. Introduction
2. Presentation
3. Diagnosis
4. Causes
5. Treatment
6 Acute Abdomen
1. History and Physical Examination
2. Clinical Pathology
3. Abdominal Imaging
4. Collection of Peritoneal Effusion
5. Analysis of Peritoneal Effusion
6. Abdominal Surgery
7. Nutritional Support
8. Conclusion
9. References
7 The Collapsed Patient
1. Introduction
2. Pathophysiology of Syncope
3. Causes of Syncope
4. Collapse or Syncope-Like Conditions
5. Patient Evaluation and Risk Stratification
6. References
8 Global Approach to the Trauma Patient
1. Introduction
2. Pathophysiology
3. Triage Evaluation and Intervention
4. Further Evaluation
5. Diagnostic Imaging
6. Conclusion
7. References
9 Reproductive Emergencies
1. Introduction
2. Female Reproductive Emergencies
3. Male Reproductive Emergencies
4. References
10 Anemia
1. Introduction
2. Etiology
3. Consequences of Anemia
4. Clinical Signs
5. Diagnosis
6. Decreased Erythropoiesis
7. Hemorrhagic Anemia
8. Hemolytic Anemia
9. References
11 Jaundice
1. Definition
2. Physiology
3. Pathophysiology
4. Evaluation of the Icteric Patient
5. Diagnostic Evaluation
6. Treatment
7. References
12 Ophthalmic Emergencies
1. Proptosis
2. Eyelid Lacerations
3. Corneal Lacerations
4. Deep Corneal Ulcers
5. Primary Glaucoma
6. Acute Anterior Uveitis
7. Anterior Lens Luxation
8. Acute Blindness
9. References
13 Vomiting, Regurgitation, and Diarrhea
1. Differentiation Between Vomiting and Regurgitation
2. Vomiting
3. Regurgitation
4. Diarrhea
5. References
14 Dysuria
1. Introduction
2. Alteration in Volume or Frequency of Urination
3. Alteration in Urine Consistency
4. Other Clinical Findings That May Be Associated With Lower Urinary Tract Disease
5. Physical Examination Findings in Patients with Lower Urinary Tract Signs
6. Additional Analytical Procedures in Patients with Dysuria
7. Management of Patients with Dysuria
8. References
15 Dermatological and Ear Disease
1. Dermatological Emergencies
2. Pyotraumatic Dermatitis
3. Pyoderma
4. Otitis Externa
5. Ectoparasites
6. Atopy
7. Conclusion
8. References
16 Toxin Exposure
1. Introduction
2. References
17 Epistaxis
1. Introduction
2. Pathophysiology
3. Further Laboratory Evaluation
4. Nasal Imaging
5. Nasal Biopsy
6. Emergency Management
7. Conclusion
8. References
18 Fever
1. Physiology of Normal Thermoregulation
2. What is Fever?
3. Is Fever Helpful or Harmful?
4. How to Differentiate Fever from Hyperthermia
5. Primary Differentials for Cause of Fever
6. Early Diagnostics to Consider for Febrile Patients
7. Treatments to Consider
8. References

Section 3 Emergency Conditions by System

A. Neurological Disorders
19 Traumatic Brain Injury:
1. Introduction
2. Pathophysiology
3. Physical Examination
4. Diagnostic Imaging
5. Treatment
6. Prognosis
7. References
20 Altered Mentation
1. Introduction
2. Initial Assessment (see Chapter 2)
3. Neuroanatomy
4. Neurological Examination
5. Differential Diagnoses and  Diagnostic Approach
6. Diagnostic Approach
7. Treatment and Monitoring
8. Conclusion
9. References
21 Seizures
1. Introduction
2. History
3. Initial Patient Assessment (see Chapter 2)
4. Neurological Examination
5. Differential Diagnoses
6. Quick Assessment Tests
7. Extended Laboratory Tests and Diagnostic Images
8. Emergency Management
9. Long-term Management of Seizures
10. References
22 Intracranial Disease
1. Clinical Signs
2. Diagnostic Tests
3. Differential Diagnoses and Prognosis
4. Infectious
5. References
23 Vestibular Disease
1. Introduction
2. Clinical Signs (Table 23.1)
3. Common Causes of Vestibular Disease
4. Diagnostics
5. References
24 Spinal Trauma
1. Causes
2. Pathophysiology
3. Initial Approach
4. Neurological Assessment
5. Diagnosis
6. Treatment of Spinal Cord Injury
7. References
25 Intervertebral Disk Disease
1. Introduction
2. Applied Anatomy
3. Pathogenesis
4. Clinical Signs
5. Diagnostics
6. Treatment
7. References
26 Diskospondylitis
1. Introduction
2. Pathophysiology
3. Causative Agents
4. Signalment
5. Clinical Signs
6. Diagnosis
7. Treatment
8. Prognosis
9. Complications
10. References
27 Lower Motor Neuron Disease
1. Introduction
2. Clinical Signs
3. Diagnosis and Initial Approach
4. Causes of Generalized Lower Motor Neuron Paresis
5. References
B. Respiratory Disease
28 Brachycephalic Syndrome
1. Introduction
2. Systemic Consequences of the Brachycephalic Obstructive  Airway Syndrome
3. Acute Upper Airway Obstruction:  Current Concepts
4. Treatment of Brachycephalic Syndrome
5. Future Directions
6. References
29 Feline Upper Respiratory Complex
1. Introduction
2. Causes/Infectious Agents
3. Clinical Presentation
4. Risk Factors
5. Diagnosis
6. Treatment (Table 29.2)
7. Prevention
8. Prognosis
9. References
30 Laryngeal Paralysis
1. Introduction
2. Clinical Signs
3. Emergency Treatment
4. Emergency Diagnostic Tests
5. Long-Term Management
6. Prognosis
7. References
31 Tracheobronchial Injury and Collapse
1. Anatomy and Physiology of the Trachea
2. Emergency Management
3. Tracheobronchial Injury
4. Tracheal and Bronchial Collapse
5. References
32 Acute Airway Obstruction
1. Emergency Examination
2. Emergency Stabilization
3. Diagnostics
4. Complications of Upper Airway Obstruction
5. Diseases Causing Upper Airway Obstruction (Table 32.1)
6. References
33 Exacerbations of Chronic Bronchitis
1. Introduction
2. Disease Syndrome
3. Diagnosis
4. Treatment (Table 33.1)
5. Causes of Exacerbation
6. Emergency Management of Disease Exacerbations
7. References
34 Feline Lower Airway Disease
1. Introduction
2. Patient History
3. Initial Assessment
4. Emergency Treatment
5. Differential Diagnosis
6. References
35 Puppy Pneumonia
1. Introduction
2. Clinical Approach
3. Diagnostic Testing
4. Treatment Options
5. Prognosis
6. Brachycephalic Dogs
7. References
36 Coughing and Hemoptysis
1. Introduction
2. Physiology
3. Differential Diagnosis
4. Diagnostic Approach
5. Treatment
6. References
37 Bronchopneumonia
1. Introduction
2. Types of Pneumonia
3. Physical Examination Findings
4. Diagnostics
5. Treatment
6. Prognosis
7. References
38 Cardiogenic Pulmonary Edema
1. Introduction
2. Diuretics
3. Vasodilators
4. Positive Inotropes
5. Vasopressors
6. Sedatives
7. Oxygen Therapy
8. Other Therapies
9. References
39 Neurogenic Pulmonary Edema
1. Introduction
2. Pathogenesis
3. Clinical Characteristics of Neurogenic Pulmonary Edema
4. Diagnosis
5. Initial Approach and Management
6. Monitoring the Effectiveness of Therapy
7. Prognosis
8. References
40 Submersion Injury
1. Introduction
2. Definitions
3. Precipitating Factors
4. Pathophysiology
5. Complications of Submersion Injury
6. Diagnosis and Treatment
7. Outcome
8. References
41 Pulmonary Hemorrhage
1. Etiology and Pathogenesis
2. Patient Evaluation
3. Diagnosis
4. Treatment
5. Outcome
6. References
42 Pulmonary Thromboembolism
1. Introduction
2. Risk Factors
3. Diseases associated with PTE
4. In-hospital risk factors
5. Other
6. Pathophysiology
7. Clinical Signs
8. Diagnosis
9. Management
10. References
43 Primary and Metastatic Pulmonary Neoplasia
1. Introduction
2. Diagnostic Tests
3. Treatment and Prognosis
4. Conclusion
5. References
44 Pneumothorax
1. Anatomy
2. Pathogenesis
3. Clinical Consequences of Pneumothorax
4. Physical Examination
5. Diagnosis
6. Treatment
7. References
45 Pleural Effusion
1. Introduction
2. Clinical Signs
3. Initial Treatment
4. Types of Effusions
5. Conclusion
6. References
46 Pyothorax
1. Introduction
2. Etiology
3. Microbiology
4. Signalment
5. Clinical Signs and Physical Examination Findings
6. Diagnosis
7. Treatment
8. Prognosis
9. References
47 Diaphragmatic Hernia
1. Anatomy
2. Types of Hernias
3. Clinical Signs
4. Diagnosis
5. Treatment
6. Complications and Prognosis
7. References
48 Penetrating Thoracic Trauma
1. Introduction
2. Etiology
3. Physical Examination and Diagnostics
4. Treatment
5. Prognosis
6. References
49 Blunt Thoracic Trauma
1. Introduction
2. Etiology
3. Pathophysiology
4. Physical Examination and Diagnostics
5. Treatment
6. Surgical Indications
7. Prognosis
8. References
50 Look-Alike Causes of Respiratory Distress
1. Introduction
2. Look-Alike Causes of Respiratory Distress
3. References
C. Cardiovascular Disease
51 Mechanisms of Heart Failure
1. What is Heart Failure?
2. Neuroendocrine Systems in Heart Failure
3. Maladaptive Responses in Heart Failure
4. Global Cardiac Function in Heart Failure
5. Treatment
6. Conclusion
7. References
52 Congenital Cardiovascular Disease
1. Introduction
2. Diagnosis
3. Cyanosis
4. Congestive Heart Failure
5. Syncope/Collapse
6. Conclusion
7. References
53 Arrhythmias
1. Introduction
2. Tachycardias
3. Bradycardias
4. References
54 Pericardial Effusion
1. Etiology
2. Pathophysiology
3. Clinical Presentation
4. Diagnostic Testing
5. Pericardiocentesis
6. Management and Prognosis
7. References
55 Dilated Cardiomyopathy
1. Introduction
2. Etiology
3. Signalment, Prevalence, and Incidence
4. Stages
5. Diagnosis
6. Diagnostic Tests
7. Treatment
8. Prognosis
9. References
10. Further Reading
56 Feline Hypertrophic Cardiomyopathy
1. Introduction and Definitions
2. Pathology and Pathophysiology
3. Presentation and Clinical Signs
4. Initial Stabilization
5. Diagnostic Tests
6. Chronic Therapy
7. Prognosis
8. References
57 Valvular Heart Disease
1. Introduction
2. Myxomatous Valvular Degeneration
3. Diagnosis (Table 57.1)
4. Pathophysiology of Congestive Heart Failure (see Chapter 51)
5. Treatment (Table 57.2)
6. Prognosis
7. References
58 Heartworm Disease
1. Introduction
2. Pathophysiology
3. Clinical Presentation and Physical Examination
4. Diagnosis (Table 58.1)
5. Treatment of Specific Syndromes
6. References
59 Pulmonary Hypertension
1. Pathophysiology
2. Classification of Pulmonary Hypertension
3. Cor Pulmonale
4. Clinical Presentation
5. Diagnosis
6. Treatment
7. Follow-Up and Prognosis
8. References
60 Bradyarrhythmias and Pacemakers
1. Introduction and Definitions
2. Physiological Bradyarrhythmias
3. Iatrogenic Bradyarrhythmias
4. Pathological Bradyarrhythmias
5. Clinical Management of Dogs and Cats with Bradyarrhythmias
6. References
61 Myocarditis
1. Introduction
2. Parvovirus
3. Chagas’ Disease
4. Lyme Disease
5. Bartonella
6. Toxoplasmosis
7. Traumatic Myocarditis
8. Diagnosis
9. Treatment
10. Further Reading
62 Thromboembolic Disease
1. Introduction
2. Pathophysiology of Thrombosis
3. Diagnosis of Thrombosis
4. General Aspects of the Treatment and Prevention of Thrombosis
5. Feline Aortic Thromboembolism
6. Canine Aortic Thrombosis
7. Portal Vein Thrombosis
8. Splenic Thrombosis
9. Mesenteric Thrombosis
10. Caval Thrombosis
11. Cerebral Infarction
12. Myocardial Thrombosis
13. References
63 Systemic Arterial Hypertension
1. Introduction
2. Pathophysiology of Systemic Hypertension
3. Target Organ Damage Caused by Systemic Hypertension
4. Conditions Associated with Systemic Hypertension
5. Clinical Recognition of Systemic Hypertension
6. Treatment of the Patient with Systemic Hypertension
7. Prognosis and Long-Term Management
8. References
D. Hematological and Oncological Disorders
64 Leukocytosis and Leukopenia
1. Introduction
2. Leukocytosis
3. Leukopenia
4. References
65 Non-Regenerative Anemia
1. Introduction
2. Erythropoiesis
3. Pathophysiological Response to Non-Regenerative Anemia
4. Diagnostic Approach
5. Primary Bone Marrow Disorders
6. Secondary Extramarrow Disorders
7. Therapies for Non-Regenerative Anemia
8. References
66 Hemolytic Anemia
1. Introduction
2. History and Physical Examination
3. Laboratory Assessment
4. Differential Diagnoses for Hemolytic Anemia
5. References
67 Thrombocytopenia
1. Platelets
2. Thrombocytopenia Etiology
3. Clinical Signs
4. Diagnosis
5. Treatment
6. References
68 Fibrinolysis and Antifibrinolytics
1. Introduction
2. Physiology of Fibrinolysis
3. Disorders of Fibrinolysis
4. Evaluation of the Fibrinolytic System
5. Management of Hyperfibrinolysis
6. Therapeutic Fibrinolysis
7. References
69 Congenital Coagulopathy
1. Introduction
2. Dogs
3. Cats
4. Animals Presenting with Unexplained Hemorrhage
5. Animals with Known Inherited Defects
6. Von Willebrand’s Disease
7. Hemophilia A
8. Hemophilia B
9. Conclusion
10. References
70 Acquired Coagulopathy
1. General Approach
2. Anticoagulant-Associated Coagulopathy
3. Disseminated Intravascular Coagulation
4. Acute Traumatic Coagulopathy
5. Hepatobiliary Disorders
6. Angiostrongylus vasorum
7. Neoplasia
8. References
71 Antithrombotics in the Emergency Room
1. Introduction
2. References
72 Sick Oncology Patients in the Emergency Room
1. Introduction
2. Febrile Neutropenia and Sepsis
3. Hypercalcemia
4. Acute Tumor Lysis Syndrome
5. Thromboembolism and Hemostatic Abnormalities
6. Hemangiosarcoma
7. Conclusion
8. References
73 Paraneoplastic Syndromes
1. Hypercalcemia of Malignancy
2. Hypoglycemia
3. Polycythemia
4. Anemia
5. Thrombocytopenia
6. Coagulopathies/Disseminated Intravascular Coagulation
7. Hypertrophic Osteopathy
8. Fever
9. Miscellaneous
10. References
E. Esophageal and Abdominal Disease
74 Vomiting and Regurgitation
1. Vomiting
2. Regurgitation
3. References
75 Esophageal Foreign Bodies
1. Introduction
2. Presentation
3. Diagnosis
4. Treatment
5. Outcome
6. References
76 Diarrhea
1. Introduction
2. Diagnostic Approach
3. Causes of Diarrhea (Table 76.1)
4. Treatment
5. References
77 Hematemesis and Gastrointestinal Hemorrhage
1. Introduction
2. Etiology and Pathophysiology
3. Clinical Signs and Physical Examination
4. Laboratory Evaluation
5. Diagnostic Imaging
6. Endoscopy
7. Exploratory Laparotomy
8. Treatment
9. Prognosis
10. References
78 Parvovirus Enteritis
1. Pathogenesis
2. Clinical Signs
3. Diagnostic Tests
4. Treatment and Monitoring
5. Prognosis
6. Husbandry Considerations
7. References
79 Hemorrhagic Gastroenteritis
1. Introduction
2. Investigation into the Underlying Etiology
3. Clinical Recognition and Diagnosis
4. Emergency Stabilization and Treatment
5. Prognosis
6. References
80 Protein-Losing Enteropathy
1. Introduction
2. Pathophysiology
3. Clinical Presentations and Laboratory Data
4. Treatment
5. Prognosis and Follow-Up Care
6. Protein-Losing Enteropathy in Feline Patients
7. References
81 Gastrointestinal Obstruction
1. Introduction
2. Etiology
3. Pathophysiology
4. Clinical Signs and Physical Exam
5. Diagnostics
6. Specific Conditions
7. Postoperative Complications and Care
8. Overview
9. References
82 Gastric Dilation-Volvulus
1. Introduction
2. Diagnosis and Treatment
3. Surgical Management
4. Outcome
5. References
83 Mesenteric Torsion
1. Introduction
2. Pathophysiology
3. History and Clinical Signs
4. Diagnostics
5. Treatment
6. References
84 Hemoperitoneum
1. Introduction
2. History and Signalment
3. Clinical Signs and Physical Examination Findings
4. Initial Treatment and Stabilization
5. Diagnostics
6. Definitive Care and Prognosis
7. References
85 Splenic Disease
1. Splenic Disease in the Emergent Patient
2. Splenic Masses in Dogs
3. Splenic Torsion
4. Splenic Trauma
5. Splenic Infarction
6. Splenic Abscesses
7. Miscellaneous Conditions Causing Diffuse Splenomegaly in Dogs
8. Feline Splenic Disease
9. References
86 Pancreatitis
1. Introduction
2. Pathophysiology
3. History, Signalment, and Clinical Signs
4. Diagnosis
5. Biopsy and FNA
6. Scoring Disease and Assessing Severity
7. Treatment
8. Prognosis and Owner Communication
9. References
87 Peritonitis
1. Introduction
2. Etiology
3. Immune Response
4. Signalment and History
5. Physical Examination
6. Diagnostics
7. Treatment
8. Prognosis
9. References
88 Postoperative Complications Presenting to the Emergency Service
1. Introduction
2. Surgical Site Complications
3. Associated Complications
4. Conclusion
5. References
89 Biliary Disease
1. Introduction
2. Overview of Anatomy and Physiology
3. Presenting Signs and Initial Physical Examination
4. Diagnostics
5. Stabilization
6. Acute Medical Therapy
7. Surgery
8. Prognosis
9. References
90 Acute Liver Failure
1. Introduction
2. Pathophysiology
3. Presenting Complaint and Clinical Signs
4. Causes
5. INFECTIOUS
6. TOXIN
7. OTHER
8. Diagnostic Tests
9. Initial evaluation:
10. Full work-up:
11. Emergency Stabilization and Treatment
12. Prognosis
13. Conclusion
14. References
91 Feeding Tube Complications
1. Introduction
2. Complications Associated with Placement of Feeding Tubes
3. Complications Associated with Feeding Tube Use
4. Complications Encountered After Placement of Feeding Tubes
5. Conclusion
6. References
92 Anorectal Disease
1. Introduction
2. Anatomy
3. Perforation
4. Rectal Prolapse
5. Other Diseases
6. References
93 Constipation
1. Introduction
2. History
3. Physical Examination
4. Diagnostics
5. Treatment
6. Prognosis
7. References
VOLUME 2
F. Urogenital Disorders
94 Acute Azotemia
1. Introduction
2. Diagnosis of Acute Azotemia
3. Treatment
4. References
95 Oliguria
1. Pathogenesis of Oligoanuria
2. Patient Assessment and Initial Diagnostics
3. Managing the Oligoanuric Patient
4. Converting Oligoanuria to Polyuria
5. Extracorporeal Renal Replacement Therapy
6. References
96 Urinary Tract Infections
1. Definition
2. Incidence and Pathogenesis
3. History and Physical Examination
4. Diagnosis
5. Therapy
6. Management of Particular Conditions
7. References
97 Urolithiasis
1. Introduction
2. Diagnosis of Uroliths
3. Management of Uroliths Associated with Urinary Obstruction
4. Management of Uroliths Unassociated with Urinary Obstruction
5. References
98 Feline Ureteral Obstruction: Diagnosis and Management
1. Introduction
2. Etiology
3. Treatment of Feline Ureteral Obstructions
4. Postoperative Management
5. Conclusion
6. References
99 Feline Lower Urinary Tract Obstruction
1. Pathogenesis of Obstruction
2. Predisposing Factors
3. Pathophysiology of Obstruction
4. History and Clinical Signs
5. Initial Stabilization
6. Urethral Catheterization
7. Diagnostic Evaluation
8. Postobstructive Care
9. Alternative Management Protocols
10. At-Home Care
11. Prognosis
12. References
100 Urethral Trauma
1. Incidence
2. Patient Evaluation
3. Diagnosis
4. Treatment
5. Complications
6. Outcome
7. References
101 Lyme Nephritis
1. Introduction
2. Transmission, Prevalence, and an Experimental Model of Canine  Lyme Disease
3. Presentation of Field Cases with Presumptive Lyme Nephritis [1–4,15]
4. Diagnostic Work-Up to Stage Disease and Rule Out Other Differentials [1–4,9,10]
5. Treatment (Table 101.2)
6. Monitoring
7. Prevention, Tick Control and  Lyme Vaccination
8. References
102 Chronic Kidney Disease
1. Introduction
2. Pathophysiology
3. Presentation
4. Diagnostics
5. Stabilization and Initial Therapy
6. Prognosis and Long-Term Management
7. Conclusion
8. References
103 Uroabdomen
1. Etiology and Pathogenesis
2. Clinical Signs and Physical Examination Findings
3. Diagnosis and Laboratory Evaluation
4. Emergent Stabilization
5. Treatment
6. Complications and Prognosis
7. References
104 Urethral Prolapse
1. Urethral Prolapse
2. Diagnosis
3. Treatment
4. References
105 Discolored Urine
1. Introduction
2. Examination of the Urine Specimen
3. Abnormal Urine Sediment Color
4. Abnormal Urine Supernatant Color
5. Pigment-Induced Renal Injury
6. Conclusion
7. References
106 Urinary Diversion in the Emergency Room
1. Urinary Catheterization
2. Percutaneous Nephrostomy Tube
3. Percutaneous Antegrade Urethral Catheterization
4. Cystoscopy and Urethroscopy
5. Cystostomy Tubes
6. Peritoneal Drainage
7. References
G. Acid-base, Electrolyte and Endocrine Disorders
107 Acid–Base Disorders
1. Introduction
2. Sample Considerations
3. Acid–Base Regulation
4. Acid–Base Analysis
5. Acid–Base Disorders
6. Acid–Base and Prognosis
7. Case Example 1
8. Case Example 2
9. Case Example 3
10. References
108 Sodium and Water Balance
1. Introduction
2. Hyponatremia
3. Hypernatremia
4. Acute (<48h) hypernatremia
5. Prognosis
6. References
109 Potassium Disorders
1. Introduction
2. Potassium Homeostasis
3. Hypokalemia
4. Hyperkalemia
5. References
110 Calcium, Magnesium, and Phosphorus Disorders
1. Introduction
2. Phosphorus Homeostasis
3. Calcium Homeostasis
4. Magnesium Homeostasis
5. References
111 Hypoglycemia
1. Introduction
2. Pathophysiology
3. Clinical Signs
4. Causes of Hypoglycemia
5. Diagnosis
6. Treatment of a Hypoglycemic Crisis
7. References
112 Hyperglycemia
1. Introduction
2. Stress Hyperglycemia
3. Diabetes Mellitus
4. Insulin Deficiency and Insulin Resistance
5. References
113 Complicated Diabetes Mellitus
1. Introduction
2. Pathogenesis
3. History and Physical Examination
4. Diagnostic Evaluation in the Emergency Room
5. Stabilization and Emergency Treatment
6. Post-crisis Therapy for Diabetes Mellitus
7. Outcome
8. References
114 Adrenal Gland Disorders
1. Introduction
2. Pheochromocytoma
3. Hyperaldosteronism
4. Hyperadrenocorticism
5. References
115 Hypoadrenocorticism
1. Etiology and Pathogenesis
2. Patient Evaluation
3. Diagnosis
4. Treatment
5. Complications
6. Outcome
7. References
116 Thyroid Disorders
1. Introduction
2. Thyroid Physiology
3. Thyroid Testing
4. Clinical Presentations
5. References
117 Diabetes Insipidus
1. Introduction
2. Pathophysiology
3. Recognizing Diabetes Insipidus in the Emergency Patient
4. Treatment
5. Prognosis
6. References
H. Reproductive Disorders
118 Dystocia
1. Female Reproductive Anatomy and the Physiology of Parturition
2. Dystocia
3. Postoperative Care and Management
4. References
119 Eclampsia
1. Introduction
2. Etiopathogenesis
3. Diagnosis
4. Treatment (Box 119.1)
5. Prevention
6. References
120 Neonatal Resuscitation
1. Physical Examination
2. Respiratory Concerns
3. Cardiac Concerns
4. Hypothermia
5. Dehydration and Fluid Therapy
6. Hypoglycemia
7. Sepsis
8. When to Stop Resuscitation Efforts
9. References
121 Diseases of the Neonate
1. Introduction
2. Epizootiology
3. Physiology
4. Neonatal Disorders in the Immediate Postpartum Period
5. Neonatal Disorders in the Later Postpartum Period
6. References
122 Metritis and Mastitis
1. Metritis
2. Mastitis
3. References
123 Pyometra
1. Signalment, Clinical Presentation, and Associated Disease
2. Diagnostics
3. Treatment
4. References
124 Prostatic Disease
1. Introduction
2. Anatomy
3. Diagnostics
4. Prostatic Disorders
5. References
125 Uterine and Vaginal Prolapse
1. Uterine Prolapse
2. Vaginal Prolapse
3. References
126 Penile, Preputial, and Testicular Disease
1. Priapism
2. Paraphimosis
3. Phimosis
4. Persistent Penile Frenulum
5. Balanoposthitis
6. Urethral Prolapse (see Chapter 104)
7. Penile Trauma
8. Infectious Orchitis and Epididymitis
9. Testicular Torsion
10. Scrotal Dermatitis
11. References
I. Common Toxins
127 Decontamination and Toxicological Analyses of the Poisoned Patient
1. Introduction
2. Gastrointestinal Decontamination
3. Emetic Agents
4. Gastric Lavage
5. Activated Charcoal
6. Toxicological Analyses
7. Conclusion
8. References
128 Lipid “Rescue” Therapy
1. Introduction
2. Available Formulations
3. Historical Use in Human Medicine
4. Use in Veterinary Medicine
5. Mechanism of Action
6. Recommended Dosing
7. Potential Complications
8. References
129 Blood Purification Techniques for Intoxications
1. Introduction
2. Intermittent Hemodialysis
3. Hemoperfusion
4. Combination Hemodialysis/Hemoperfusion
5. Apheresis
6. Indications for the Use of Extracorporeal Therapies in Treatment of Poisoning
7. Medical Management for Intoxications
8. Conclusion
9. References
130 Rodenticide Toxicity
1. Introduction
2. Decontamination
3. Anticoagulant Rodenticides
4. Neurotoxic Rodenticides
5. Cholecalciferol Rodenticides
6. Phosphide Rodenticides
7. Aldicarb Rodenticide
8. References
131 Ethylene Glycol Intoxication
1. Introduction
2. Clinical Signs
3. Diagnostic Testing
4. Treatment
5. Hemodialysis
6. References
132 Acetaminophen Intoxication
1. Introduction
2. Pharmacokinetics and Toxicokinetics
3. Clinical Signs
4. Gross and Histological Lesions
5. Diagnosis
6. Treatment
7. Prognosis
8. References
133 Non-Steroidal Anti-Inflammatory Drug Intoxications
1. Mechanism of Action
2. Pharmacokinetics
3. Adverse Effects
4. Treatment of NSAID Intoxication
5. References
134 Grape, Raisin, and Lily Ingestion
1. Grape, Raisin, and Currant Nephrotoxicity Pathogenesis
2. Lily Nephrotoxicity Pathogenesis
3. Physical Examination
4. Initial Diagnostics
5. Management of Non-Azotemic Animals Shortly After Exposure
6. Managing Patients with Established Acute Kidney Injury
7. Prognosis
8. References
135 Recreational Drug Intoxications
1. Cocaine
2. Methamphetamine
3. Marijuana
4. Conclusion
5. References
136 Household Toxins
1. Decontamination
2. Common Household Toxin Exposures
3. Conclusion
4. References
J. Skin and Soft Tissue Disease
137 Life-Threatening Dermatological Emergencies
1. Dermatological Emergencies
2. Methicillin-Resistant Staphylococcal Infections (MRSIs)
3. Burns
4. Frostbite
5. Drug Eruption
6. Vasculitis
7. Erythema Multiforme
8. Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome
9. References
138 Severe Soft Tissue Infections
1. Introduction
2. Etiology
3. Pathophysiology
4. Clinical Features (Table 138.1)
5. Diagnosis (see Table 138.1)
6. Treatment (see Table 138.1)
7. Prognosis
8. References
K. Environmental Emergencies
139 Smoke Inhalation Toxicity
1. Introduction
2. Pathophysiology of Smoke Inhalation
3. Carbon Monoxide and Cyanide Exposure
4. Physical Examination Findings
5. Diagnostics
6. Treatment
7. Prognosis
8. References
140 Porcupine Quilling
1. Introduction
2. Prehospital Care
3. Quill Removal
4. Discharge Instructions
5. Complicated Quillings
6. Conclusion
7. References
141 Crotalinae Snake Envenomation
1. Introduction
2. Crotalinae Envenomation
3. Clinical Signs of Envenomation
4. Patient Evaluation and Stabilization
5. Antivenoms
6. Additional Therapies
7. References
142 Elapid Snake Envenomation: North American Coral Snakes and Australian Elapids  (Tiger Snakes, Brown Snakes, Taipans, Death Adders, and Black Snakes)
1. Introduction
2. Elapid Species Identification
3. Pathophysiology of Elapid Venoms
4. Clinical Signs of Envenomation
5. First Aid Advice for Owners
6. Treatment of Envenomation in Dogs  and Cats
7. References
143 Spider and Scorpion Envenomation
1. Spider Envenomation
2. Theraphosidae Spiders
3. Scorpion Envenomation
4. References
144 Bufo Toad Toxicosis
1. Introduction
2. Incidence
3. Signalment
4. Clinical Signs of Envenomation
5. Diagnosis
6. Treatment and Monitoring
7. Prognosis
8. Acknowledgments
9. References
145 Hymenoptera Envenomation
1. Apoidea
2. Vespoidea
3. Formicidea
4. Venom
5. Lethal Dose
6. Clinical Manifestations of Envenomation
7. Diagnosis
8. Treatment
9. References
146 Hypersensitivity and Anaphylaxis
1. Incidence and Definitions
2. Classification and Pathophysiology of Hypersensitivity Reactions and Anaphylaxis
3. Etiologies and Clinical Manifestations
4. Diagnosis
5. Treatment
6. Prognosis
7. References
147 Canine Heat Stroke
1. Pathophysiology
2. Risk Factors for Developing Heat Stroke
3. Clinical Signs and Diagnosis
4. Hematological Disorders and Biochemical Abnormalities
5. Coagulation Disorders and Disseminated Intravascular Coagulation
6. Other Complications: Acute Kidney Injury, Central Nervous System Dysfunction, ARDS, Cardiac Arrhythmias, and Gastrointestinal Bacterial Translocation
7. Treatment Options
8. Monitoring
9. Prognosis
10. Conclusion
11. References
148 Cold Exposure
1. Introduction
2. Pathophysiology of Effects of Cold Exposure [1–3,6–10]
3. Management [1–3,7–10]
4. Frostbite
5. References
149 Electrical and Lightning Injuries
1. Introduction
2. Electrical Injury
3. Lightning Injury
4. References

Section 4 Trauma and Resuscitation

A. Cardiopulmonary Resuscitation
150 Cardiopulmonary Resuscitation in the Emergency Room
1. Recognition of Cardiopulmonary Arrest
2. Basic Life Support
3. Advanced Life Support
4. Prognosis
5. References
151 Small Animal Cardiopulmonary Resuscitation Initiatives
1. Strategically Advancing the Field  of Veterinary CPR
2. Evidence-Based Consensus Small Animal CPR Guidelines
3. Knowledge Gaps
4. Glossary and Guidelines For Standardized Reporting
5. CPR Registry
6. Conclusion
7. References
B. Circulatory Shock
152 Pathophysiology of Shock
1. Introduction
2. Cellular Impact
3. Systemic Impact
4. Secondary Systemic Sequelae
5. Conclusion
6. References
153 Hypovolemic Shock
1. Pathophysiology of Hypovolemic Shock
2. Diagnosis of Hypovolemic Shock
3. Treatment of Hypovolemic Shock
4. Complications of Hypovolemic Shock
5. References
154 Cardiogenic Shock
1. Introduction
2. Pathophysiology (see Chapter 152)
3. Incidence and Etiology
4. Diagnosis
5. Treatment and Monitoring
6. Conclusion
7. References
155 Additional Mechanisms of Shock
1. Introduction
2. Distributive Shock
3. Obstructive Shock
4. Non-Circulatory Shock
5. References
156 Lactate Monitoring
1. Introduction
2. Lactate Physiology
3. Causes of Hyperlactatemia
4. Lactate Measurement
5. Normal Lactate Concentration
6. Assessment of Hyperlactatemia
7. Prognostic Implications
8. Lactate Measurement in Other Body Fluids
9. References
157 Emerging Monitoring Techniques
1. Introduction
2. Venous Oxygen Monitoring
3. Peripheral Hemodynamic Parameters
4. References
158 Ischemia-Reperfusion Injury
1. Pathophysiology
2. Disorders Associated with Ischemia-Reperfusion Injury
3. Identification of Ischemia-Reperfusion Injury
4. Management of Ischemia-Reperfusion Injury
5. Conclusions and Clinical Recommendations
6. References
159 Systemic Inflammatory Response Syndrome, Sepsis, and  Multiple Organ Dysfunction Syndrome
1. Introduction
2. Definitions
3. Pathophysiology
4. Diagnostic Approach to SIRS and Sepsis
5. Treatment Approach to SIRS and Sepsis
6. Prognosis for SIRS, Sepsis, and MODS
7. References
C. Trauma
160 Trauma Overview
1. Introduction
2. Overview of the Pathophysiology of Trauma
3. Epidemiology of Small Animal Trauma
4. Trauma Scoring Systems
5. General Approach to the Polytrauma Patient
6. Considerations for Intravenous Fluid Resuscitation in Trauma
7. References
161 Trauma Center Registry
1. Veterinary Trauma Initiative
2. Trauma Registries: History and Purpose
3. Trauma Registry: The Future
4. References
162 High-Rise Syndrome
1. Definition and Pathophysiology
2. Clinical Signs
3. Diagnostics
4. Treatment
5. Prognosis
6. References
163 Trauma-Associated Coagulopathy
1. Introduction
2. Pathogenesis
3. Trauma-Associated Coagulopathy in Dogs
4. Hemostatic Testing for Trauma
5. Conclusion
6. References
164 Metabolic Consequences of Trauma
1. Introduction
2. Sympathoadrenal Activation
3. Neuroendocrine Activation
4. Hyperglycemia
5. Hyperlactatemia
6. Acid–Base Disorders
7. Body Temperature
8. Gastrointestinal Injury
9. Systemic Inflammation
10. Activation of the Coagulation Cascade
11. Conclusion
12. References
165 Traumatic Orthopedic Emergencies
1. General Considerations for the Trauma Patient
2. Fractures
3. Traumatic Joint Injuries
4. Skull and Maxillofacial Trauma
5. References
166 Wound Management Principles
1. Introduction
2. Phases of Wound Healing
3. Wound Closure
4. Management of Acute Traumatic Wounds and Deciding When and How to Close Them
5. Antibiotic Therapy in Wound Management
6. References

Section 5 Fluid and Blood Product Therapy

167 Crystalloid Fluid Therapy
1. Introduction
2. Physiology of Fluid Distribution
3. Patient Assessment
4. Types of Crystalloids
5. Crystalloid Fluids in Resuscitation
6. Crystalloid Fluids for Rehydration and Maintenance
7. Complications of Crystalloid Fluid Therapy
8. References
168 Colloid Fluid Therapy
1. Introduction
2. Colloid Osmotic Pressure
3. Types of Colloid Solutions
4. Conclusion
5. References
169 Crystalloids Versus Colloids
1. Introduction
2. Suitability
3. Fluid Prescription: Crystalloids (see Chapter 167)
4. Fluid Prescription: Colloids (see Chapter 168)
5. Fluids: Strategies, Dosages, and Endpoints
6. References
170 Management of Hemorrhagic Shock
1. Signalment/History
2. Physical Examination
3. Point-of-Care Diagnostics
4. Treatment
5. Additional Therapy for Specific Conditions
6. References
7. Supplemental Reading
171 Management of Dehydration
1. Introduction
2. Definition of Dehydration
3. Estimating Dehydration
4. Total Body Water
5. Mechanism of Thirst
6. Rehydration
7. Conclusion
8. References
172 Maintenance Fluid Therapy
1. Introduction
2. Estimation of a Patient’s “Maintenance” Fluid Requirement
3. Composition of a Maintenance Fluid
4. Use of Maintenance Fluids
5. Conclusion
6. References
173 Potassium Supplementation
1. Introduction
2. Potassium Physiology
3. Causes of Hypokalemia
4. Clinical Signs of Hypokalemia
5. Potassium Supplementation
6. Diabetic Ketoacidosis (see Chapter 113)
7. References
174 Administration of Sodium Bicarbonate
1. Introduction
2. Metabolic Acidosis (see Chapter 107)
3. Cardiopulmonary Cerebral Resuscitation (see Chapter 150)
4. Hyperkalemia (see Chapter 109)
5. Dosage and Administration
6. References
175 Continuous-Rate Infusion
1. Preparing Drug Solutions for Infusions
2. Fluid Bag Delivery
3. Drug Infusions Using a Burette
4. Preparation of Drug Infusions for Bag/Burette
5. Labeling the Drug Infusion
6. Standardized Concentration Infusions
7. Drug Infusions Using a Syringe Pump
176 Transfusion of Red Blood Cells and Plasma
1. Transfusion Therapy
2. Donor and Recipient Screening
3. Cross-Matching
4. Blood Product Administration
5. Transfusion Reactions
6. References
177 Massive Transfusion
1. Introduction
2. Common Conditions Requiring  Massive Transfusion
3. Diagnosis/Prediction
4. Pre-Resuscitation Complications/Acute Traumatic Coagulopathy
5. Treatment
6. Complications
7. Prognosis
8. References

Section 6 Emergency Room Procedures

178 Vascular Access
1. Introduction
2. Venous Access
3. Intraosseous Access
4. Arterial Access
5. References
179 Intraosseous Catheters
1. Introduction
2. Physiology
3. Indications
4. Contraindications
5. Medications
6. Methods
7. Possible Complications
8. Intraosseous Catheter Care
9. References
180 Airway Management
1. Introduction
2. Healthy Dog or Cat
3. Upper Airway Obstruction (see Chapters 28  and 30–32)
4. Difficult Intubation
5. Tracheostomy
6. Pharmacological Therapy
7. References
181 Oxygen Therapy
1. Introduction
2. Non-Invasive Oxygen Therapy
3. Advanced Oxygen Delivery Methods
4. Invasive Oxygen Delivery Methods
5. Hyperbaric Oxygen
6. Monitoring Response to Oxygen Therapy
7. Oxygen Toxicity
8. Conclusion
9. References
182 Sonography in the Emergency Room
1. Terminology
2. Abdominal Focused Assessment of Sonography for Trauma (FAST)
3. Thoracic FAST
4. Vet BLUE
5. Global FAST
6. References
183 Thoracocentesis
1. Introduction
2. Indications
3. Contraindications
4. Preparation and Considerations
5. Procedure
6. Identify Anatomical Landmarks
7. Complications
8. Postprocedure Monitoring
9. References
184 Thoracostomy Tube Placement
1. Indications for Thoracostomy Tubes
2. Preparation for Placement
3. Tube Types
4. Tube Placement Techniques
5. Thoracostomy Tube Maintenance and Care
6. Complications
7. References
185 Pericardiocentesis
1. Etiology and Indications for Pericardiocentesis
2. Contraindications
3. Sedation (see Chapter 192)
4. Equipment
5. Procedure
6. Complications
7. Pearls of Wisdom
8. References
186 Abdominocentesis
1. Introduction
2. Indications
3. Technique
4. Focused Assessment with Sonography  for Trauma (see Chapter 182)
5. Preparation of the Patient
6. Diagnostic Peritoneal Lavage
7. Abdominal Fluid Analysis
8. Conclusion
9. References
187 Urethral Catheterization (Including Urohydropulsion)
1. Introduction
2. Indications for Urethral Catheterization
3. Risks of Urethral Catheterization
4. Catheter Considerations
5. Placement Technique
6. Retrograde Urohydropropulsion
7. Indwelling Catheter Care
8. References
188 Mechanical Ventilation in the Emergency Room
1. Introduction
2. Supplies Required
3. Personnel
4. Transport
5. Owner Communication
6. Respiratory Distress (Hypoxemia)
7. Intoxications/Envenomation
8. Post Cardiopulmonary Resuscitation
9. Tetraparesis
10. Ventilation
11. Conclusion
12. References
189 Damage Control Surgery
1. Introduction
2. Damage Control Surgery Stage 1:  Initial Laparotomy
3. Damage Control Surgery Stage 2:  ICU Resuscitation
4. Damage Control Surgery Stage 3:  Definitive Reconstruction
5. References

Section 7 Anesthesia and Analgesia for the Emergency Room Patient

190 Anesthesia and Analgesia in the Emergency Room: An Overview
1. Introduction
2. Origins and Sequelae of Pain
3. General Approach to the Painful Patient
4. Treating the Painful Emergent Patient
5. Analgesic Agents and Tranquilizers
  (Figure 190.1)
6. Induction Agents (see Figure 190.1)
7. Inhalant Anesthetics (see Figure 190.1)
8. Conclusion
9. References
191 Anesthetic Concerns and Protocols for Common Conditions
1. Introduction
2. Dystocia/Cesarean Section  (see Chapter 118)
3. Enucleation/Proptosis
4. Foreign Body (Esophageal, Gastric, Intestinal)
5. Gastric Dilation-Volvulus (see Chapter 82)
6. Hemoabdomen (see Chapter 84)
7. Major Wounds (see Chapter 166)
8. Pacemaker
9. Urethral Obstruction (Canine)
10. References
192 Sedation for the Emergency Room Patient
1. Introduction
2. Healthy Dog/Cat Emergencies
3. Geriatric, Debilitated, or Hemodynamically Unstable Cat or Dog Emergencies
4. Sedation Agents
5. Induction Agents Used for Sedation
6. References
193 Pain Management in Critical Patients
1. Pain in the Emergency Patient: Concerns and Goals
2. How Much Pain and How to Approach It
3. Drug Interactions
4. Dose Titration, Timing, and Duration
5. Breakthrough and Unexpected Pain
6. Pharmacological Methods for Treating Acute Pain
7. Cryotherapy
8. References
194 Opioids
1. Introduction
2. Mechanism of Action
3. Duration of Action and Administration Techniques
4. Advantages and Side-Effects
5. Patient Management Recommendations
6. References
195 Alpha-2 Adrenergic Agonists
1. Introduction
2. References
196 Non-Steroidal Anti-Inflammatory Drugs
1. Introduction
2. Mechanisms of Action
3. Pharmacokinetics
4. Adverse Effects
5. Drug–Drug Interactions
6. Clinical Usage
7. References
197 Regional Anesthesia Techniques
1. Introduction
2. Selected Regional Anesthetic Techniques
3. Potential Complications
4. References
198 Go Home Analgesics
1. Pain Assessment
2. Pathophysiology of Pain
3. Go Home Analgesics
4. Adjunctive or Alternative Analgesics
5. References
199 Approach to the Aggressive or Fearful Emergency Room Patient
1. Introduction
2. Patient Fear and Aggression
3. Recognizing Fear and Aggression  in Dogs and Cats
4. Techniques for Patient Handling and Physical Restraint
5. Pharmacologic Restraint of the Aggressive or Fearful Patient
6. References

Section 8 Unique Emergency Medicine Topics

200 Antimicrobial Therapy in the Emergency Patient
1. Introduction
2. General Considerations for Antimicrobial Selection
3. Approach to Antimicrobial Selection for Patients with Sepsis
4. Duration of Antimicrobial Administration
5. Source Control
6. Conclusion
7. References
201 Disaster Medicine
1. What is a Disaster?
2. The Human–Animal Bond During a Disaster
3. Organizational Structure
4. Veterinary Disaster Response Programs
5. Phases of Disaster Management
6. Conclusion
7. References
202 Working Dogs in the Emergency Room
1. Occupations
2. Occupational Hazards
3. Client Education
4. References
203 Approach to Unowned and Shelter/Rescue Animals in the Emergency Room
1. Introduction
2. References
204 Euthanasia Considerations
1. Introduction
2. Emotional Aspects of Euthanasia in the Emergency Setting
3. Technical Aspects of Euthanasia in the Emergency Setting
4. Current Concepts in Veterinary End-of-Life Care
5. Conclusion
6. References
205 Emergency Room Design and Staffing Models
1. Introduction
2. General Design Concepts
3. Entrance
4. Reception
5. Waiting Room
6. Exam Rooms
7. Visitation, Consulting, and Grieving Rooms
8. Emergency Room
9. Other Hospital Space
10. Other Design Considerations for the Emergency Room
11. Design Summary
12. Staffing the Emergency Room
206 Conflict in the Emergency Room
1. Introduction
2. Interpersonal Conflict
3. Enhancing Constructive Conflict
4. Conclusion
5. References
207 Maximizing Communication
1. Core Communication Skills
2. Breaking the News/Presenting the Diagnosis
3. Offering Options
4. Specific Pointers
5. Conclusion
6. References
208 Basics of Clinical Study Design
1. Introduction
2. The Research Question
3. Choosing the Appropriate Subjects
4. Planning and Recording the Measurements
5. Choosing the Study Design
6. Analysis
7. Presenting the Results
8. Further Reading
209 Designing and Participating in Clinical Trials
1. Clinical Trial Design
2. Controlled Clinical Trial Design
3. Clinical Trial Implementation
4. Good Clinical Practice
5. References

Index

End User License Agreement

List of Tables

Table 2.1
Table 2.2
Table 2.3

Table 3.1
Table 3.2
Table 3.3
Table 3.4

Table 7.1
Table 7.2
Table 7.3
Table 7.4
Table 7.5

Table 10.1

Table 13.1
Table 13.2

Table 15.1
Table 15.2
Table 15.3
Table 15.4
Table 15.5
Table 15.6
Table 15.7
Table 15.8
Table 15.9
Table 15.10

Table 16.1

Table 18.1
Table 18.2

Table 20.1

Table 21.1
Table 21.2

Table 22.1

Table 23.1
Table 23.2

Table 24.1

Table 25.1
Table 25.2

Table 27.1
Table 27.2

Table 28.1

Table 29.1
Table 29.2

Table 31.1

Table 32.1

Table 33.1

Table 35.1

Table 37.1

Table 38.1

Table 44.1

Table 45.1

Table 46.1

Table 49.1
Table 49.2

Table 52.1

Table 53.1
Table 53.2

Table 55.1
Table 55.2

Table 57.1
Table 57.2

Table 58.1

Table 63.1
Table 63.2

Table 65.1

Table 68.1
Table 68.2

Table 70.1
Table 70.2

Table 73.1

Table 74.1

Table 76.1

Table 78.1

Table 80.1
Table 80.2

Table 86.1

Table 87.1

Table 90.1

Table 93.1

Table 94.1
Table 94.2
Table 94.3

Table 95.1

Table 96.1
Table 96.2

Table 99.1

101

Table 101.1
Table 101.2

102

Table 102.1
Table 102.2

103

Table 103.1

105

Table 105.1

107

Table 107.1
Table 107.2

109

Table 109.1
Table 109.2
Table 109.3

110

Table 110.1

111

Table 111.1

113

Table 113.1
Table 113.2
Table 113.3

115

Table 115.1
Table 115.2
Table 115.3

116

Table 116.1

117

Table 117.1

118

Table 118.1
Table 118.2

119

Table 119.1

120

Table 120.1
Table 120.2

123

Table 123.1

125

Table 125.1

126

Table 126.1

127

Table 127.1
Table 127.2
Table 127.3
Table 127.4

129

Table 129.1

133

Table 133.1

135

Table 135.1
Table 135.2
Table 135.3

137

Table 137.1
Table 137.2
Table 137.3
Table 137.4

138

Table 138.1

141

Table 141.1

142

Table 142.1

143

Table 143.1
Table 143.2

144

Table 144.1

145

Table 145.1

146

Table 146.1

147

Table 147.1

151

Table 151.1

153

Table 153.1

158

Table 158.1
Table 158.2

159

Table 159.1
Table 159.2
Table 159.3

160

Table 160.1

165

Table 165.1

167

Table 167.1
Table 167.2
Table 167.3

168

Table 168.1
Table 168.2

169

Table 169.1
Table 169.2
Table 169.3

170

Table 170.1
Table 170.2
Table 170.3
Table 170.4

171

Table 171.1
Table 171.2

172

Table 172.1

173

Table 173.1

174

Table 174.1
Table 174.2

175

Table 175.1

176

Table 176.1
Table 176.2

179

Table 179.1

182

Table 182.1
Table 182.2
Table 182.3
Table 182.4
Table 182.5

183

Table 183.1

188

Table 188.1

191

Table 191.1

192

Table 192.1

194

Table 194.1

195

Table 195.1

197

Table 197.1

198

Table 198.1
Table 198.2

199

Table 199.1
Table 199.2
Table 199.3

200

Table 200.1

202

Table 202.1
Table 202.2

204

Table 204.1

206

Table 206.1
Table 206.2